Dr. Cherkin: Chronic low back pain is a widespread, costly, and potentially disabling problem. It’s the most common cause of pain of any kind. It affects eight in 10 Americans at some point in their lives. In recent years, the United States has been spending more on back pain treatments—but unfortunately with worse results in how much pain bothers people and interferes with their lives. Group Health is addressing the problem in several ways, including this innovative research.

MedicalResearch.com: What are the main findings?

Dr. Cherkin: In a randomized controlled trial involving more than 300 patients at Group Health, we found that training in a kind of mindfulness meditation—mindfulness-based stress reduction (MBSR)—led to meaningful improvements in functioning and chronic low back pain at six months and one year. MBSR, which is becoming increasingly popular and available in the United States, involves training in observing, acknowledging, and accepting thoughts and feelings including pain. The training also includes some easy yoga poses to help participants become more aware of their bodies. Results with mindfulness-based stress reduction were significantly better than with usual care (whatever patients would be doing for their back pain if they weren’t in the study, including medications and physical therapy—but not mindfulness meditation or cognitive behavioral therapy). And results with mindfulness-based stress reduction were very similar to those with cognitive behavioral therapy (CBT). CBT includes education about chronic pain, relationships between thoughts and emotional and physical reactions, instruction and practice in changing dysfunctional thoughts, setting and working towards behavioral goals, relaxation skills, activity pacing, and pain coping strategies. Prior studies had already proven that CBT helped adults of various ages with back pain.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Cherkin: Mindfulness-based stress reduction may be an effective treatment option for people with chronic low back pain. The persistence of the effects at one year suggest that this training gives people long-lasting skills to improve how they manage pain by changing how their brains respond to pain signals.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Cherkin: We want to see whether the effects of mindfulness and CBT persist for more than a year. And we want to learn whether mindfulness and CBT affect people through the same or different processes. For example, do the benefits of mindfulness training result from increased mindfulness and acceptance of pain, whereas the benefits of cognitive behavioral therapy result from changes in pain beliefs and more effective use of pain coping strategies?

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